OBJECTIVES: Historical comparative cost analyses have included adalimumab (ADA), etanercept (ETA), and infliximab (IFX). More recently, certolizumab pegol (CTP) and golimumab (GLM) have been FDA-approved for use in RA. The objective of this analysis was to estimate and compare annual drug and treatment costs of all anti-TNF agents approved for use in RA based on FDA-approved prescribing information. METHODS: A cost analysis was conducted using FDA-approved prescribing information to calculate cumulative dose and administration schedule over a 12-month time horizon. Wholesale acquisition costs were obtained from First Databank for December 2009, with annual costs computed using labeled dosing. ADA cost was based on 26 injections of 40 mg every other week. CTP cost was calculated based on 15 injections of 400 mg (weeks 0, 2, and 4 loading doses and 400 mg every 4 weeks maintenance dosing). ETA cost was based on 52 injections of 50 mg once weekly. GLM cost was based on 12 injections of 50 mg once monthly. IFX cost was calculated based on 100 mg vials for initial dosing of 3 mg/kg (75 kg patient) with dose increase to 5 mg/kg at 6 months (weeks 0, 2, and 6 loading doses with every 8 week maintenance infusions; infusion fee=$181.05 per infusion from 2009 CMS Physician Fee Schedule). Costs of adverse events and concomitant methotrexate were assumed equivalent across all agents. A sensitivity analysis was conducted to assess impact of average sales price (ASP) on results. RESULTS: Annual drug only costs were $19,812 (ADA), $21,940 (CTP), $20,190 (ETA), $19,824 (GLM), and $16,306 (IFX). Including administration fees for infusion, the annual treatment cost of IFX was $17,754. A sensitivity analysis using ASP + 6% yielded similar results. CONCLUSIONS: Annual treatment costs of anti-TNF agents, including newer agents, are comparable when used for RA patients according to label.